Why Do Physicians Choose Pain as a Specialty?

Objective: Numerous forces shape the practice of pain management: scientific advances, technical advances, societal expectations, public health crises, reimbursement factors, and the parameters of who gets trained and what motivates the trainees. In this observational study, we sought to determine expressed motivations for entering the subspecialty of pain management, and in particular whether applicants were more interested in procedural skills (our hypothesis) or rehabilitative and cognitive practices.

Methods: We analyzed the personal statements of 142 applicants to the University of Minnesota's pain medicine fellowship program.

Computerized mobilization of the cervical spine for the treatment of chronic neck pain.

Background: Manual therapies for chronic neck pain (NP) are imprecise, inconsistent, and brief because of therapist fatigue.

Objective: Investigate the safety and efficacy of computerized mobilization of the cervical spine in the sagittal plane for the treatment of chronic NP.

Design: Pilot open trial.

Dexmedetomidine infusion for the management of opioid-induced hyperalgesia.

Objective: Understanding the actions of opioids now encompasses pronociceptive as well as antinociceptive mechanisms. Opioid-induced hyperalgesia (OIH) refers to increased pain sensitivity due to high-dose or prolonged opioid exposure. It has become more important as patients with pain remain on opioids at higher doses for longer periods of time.

A primer on acupuncture.

Although widely practiced in China for 2,000 years, acupuncture was introduced in the United States 40 years ago, and it has only gained acceptance by the medical establishment here in recent years. Now, a growing body of evidence supports its efficacy for a number of conditions, and it is being routinely recommended for them. This article provides an overview of acupuncture and reviews some of the evidence showing its effectiveness for treating various conditions.

Do pain specialists meet the needs of the referring physician? A survey of primary care providers.

Objective: To study the factors that influence the use of opioids in the management of chronic noncancer pain (CNCP) by primary care providers (PCPs) for patients returning from a pain specialist.

Design: A survey of PCPs.

Setting: Two physician groups in the Minneapolis-St.

The DIRE score: predicting outcomes of opioid prescribing for chronic pain.

Unlabelled: The objective of this retrospective study was to test the validity and reliability of a scoring tool (the DIRE Score), for use by clinicians, that predicts which chronic noncancer pain patients will have effective analgesia and be compliant with long-term opioid maintenance treatment. DIRE scores were assigned to 61 cases from the pain center's databases. These cases were abstracted into vignettes that were reviewed and scored by 6 physicians.

Diabetic peripheral neuropathic pain: case studies.

Three case reports in this article illustrate the diagnostic methods used and the treatment course encountered for many patients with diabetic peripheral neuropathic pain (DPNP). Each case addresses an aspect of DPNP: pain that appears to be refractory to initial therapy, DPNP occurring with other medical conditions, and nondiabetlc neuropathy occurring in patients with diabetes mellitus. Together, these cases bring clarity to the confusing clinical experience for patients who have decreased sensation in combination with burning pain, and they apply the consensus guidelines for DPNP.

Consensus guidelines: treatment planning and options. Diabetic peripheral neuropathic pain.

Despite the number of patients affected by diabetic peripheral neuropathic pain (DPNP), little consensus exists about the pathophysiology, best diagnostic tools, and primary treatment choices. Theories about the causes of DPNP are inextricably linked with the causes of diabetic neuropathles, yet most patients with such neuropathies do not experience pain. The factors that differentiate patients with pain from those without remain unknown and are the subject of much research.

Improving pain management after total joint replacement surgery.

Purpose: To test the effects of implementing evidence-based postoperative pain management content and strategies on patient, provider (nurse and physician), and fiscal outcomes.

Sample: 118 patients, 57 before and 61 after implementation, having total knee replacement (TKR) (54%) and total hip replacement (THR) (45%), and 28 orthopaedic nurses.

Methods: A research utilization approach with a pretest/posttest design was used.

Following the clues to neuropathic pain. Distribution and other leads reveal the cause and the treatment approach.

Neuropathic pain can seem enigmatic at first because it can last indefinitely and often a cause is not evident. However, heightened awareness of typical characteristics, such as the following, makes identification fairly easy: The presence of certain accompanying conditions (e.g.

Opioids for chronic nonmalignant pain. Choosing suitable candidates for long-term therapy.

Opioid maintenance analgesia for chronic nonmalignant pain can be successful in selected cases, but it is not a panacea for all pain, and management of patients using opioids can be an arduous process. A consistent and principle-based approach is recommended. Passion and chauvinism exist on both sides of the controversy and should be discouraged.

Institutionwide pain management improvement through the use of evidence-based content, strategies, resources, and outcomes.

The Agency for Health Care Policy and Research pain guidelines and implementation theories were used in this improvement initiative to ensure that evidence-based pain management reached every provider and patient in a large tertiary care hospital. Implementation strategies, products, and outcome measures are described for use in the clinical setting. Critical success factors and implementation barriers are also addressed.

Complex regional pain syndrome.

The term "complex regional pain syndrome" encompasses causalgia and reflex sympathetic dystrophy. Symptoms of burning pain with autonomic and tissue changes begin shortly after an injury, usually to a distal extremity. The diagnosis is based on the history and the clinical findings.

Pharmacologic management of cancer pain in rural Minnesota.

Use of analgesic medications for cancer pain was assessed in six Minnesota communities. In our survey, cancer patients were treated primarily by family practice physicians. Approximately 70% were given one or more analgesics; 84% received a nonsteroidal antiinflammatory drug and 73% received an opioid.

Exertional Headache.

In brief Exertional headaches can occur brief dynamic efforts such as running and swimming. They can also stem from static exertion such as weight lifting. Described here are two patients who experienced headaches of sudden onset while waterskiing.

The comparison of patients suffering from temporomandibular disorders and a general headache population.

The purpose of this study was to examine the possible association of signs and symptoms of temporomandibular disorders relative to headache. Fifty-six sequential patients referred to the Headache Institute of Minnesota for evaluation and treatment of migraine and tension headaches were examined for signs and symptoms of temporomandibular disorders. The results of the examination of headache patients were compared to patients suffering from myofascial pain dysfunction and/or TMJ internal derangements from the TMJ and Craniofacial Pain Clinic at the University of Minnesota.

Pain in hospitalized patients with medical illnesses.

To evaluate the prevalence of pain in hospitalized patients with medical illness, we retrospectively reviewed the records of 313 consecutive admissions to the medical service of the Hennepin County Medical Center. Of the 224 eligible patients, 157 (70.1%) experienced nonprocedural pain on presentation or in the hospital, and pain was the chief complaint of 34.

Diabetic neuropathy. Helping patients cope with their pain.

Diabetic neuropathy may have a metabolic or an ischemic origin, and the pattern of nerve damage varies by cause. Treatment should address the underlying cause. Patient reassurance, relaxation techniques, glucose control, use of tricyclic antidepressants or anticonvulsants, and surgical decompression for entrapment neuropathy are currently the mainstays of treatment.

Cocaine-related vascular headaches.

The records of 21 patients admitted to hospital from January 1985 to December 1988 for acute headache associated with cocaine intoxication were reviewed. Fifteen patients were identified who experienced headaches with migrainous features in the absence of neurological or systemic complications. None of them had a history of cocaine-unrelated headaches or a family history of migraine, and all had a favourable outcome.